SEA/SEIU Local 1984 membership form

Yes! I want to join with my fellow employees and become a member of SEA/SEIU Local 1984.

Contact Information

First Name Last Name

Date of Birth

Street Address

ZIP Code City State

Email Home Phone (Optional) Mobile Phone* (Optional)

* By providing my phone number, I understand the Service Employees International Union, its local unions, and affiliates may use automated calling technologies and/or text messaging me on my cellular phone on a periodic basis. SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.

(Optional)

Employer Information

Worksite Employer

I am retired

Job title

Authorization for Membership

Check boxes below and type your name as a digital signature.

Authorization for Membership **

Yes

Type name

Authorization for Payroll Deductions ***

Yes

Type name

** Membership Authorization: I hereby request and voluntarily accept membership in SEA/SEIU Local 1984 and I agree to abide by its Constitution and Bylaws and by the Service Employees International Union Constitution and Bylaws. I authorize SEA to act as my exclusive representative in collective bargaining over wages, benefits and other terms and conditions of employment with my employer.

*** Dues Deduction/Check Off Authorization: I recognize the need for a strong union and believe everyone represented by our employer to deduct from my earnings and to pay over to SEA an amount equal to the regular dues uniformly applicable to members of SEA. This authorization shall remain in effect and shall be irrevocable unless I revoke it by sending written notice via U.S. mail to SEA during the fifteen-day period commencing with my anniversary date of employment, and/or in accordance with the required maintenance language of the applicable collective bargaining agreement. I acknowledge that my dues deduction authorization is a contractual agreement between myself, as a bargaining unit employee, and SEA/SEIU Local 1984, separate from any statutory provisions of NH RSA 273-A.